Surgical Techniques for Lower Esophageal Diverticula

An epiphrenic diverticulum is a relatively rare condition typically associated with esophageal motility disorders. These diverticula are found in the distal 10 cm of the esophagus and due to an outflow obstruction at the gastroesophageal junction. Patients present with a range of symptoms that include epigastric pain, reflux, and dysphagia. Workup of these patients should include upper endoscopy, manometry, and barium esophagram. In symptomatic patients, surgical treatment is considered standard of care. The optimal surgical approach in these patients is debatable, but it is typically done using minimally invasive techniques. This may include laparoscopy, thoracoscopy, or robotics. Depending on the technique chosen, the same technical principles apply when treating these patients: diverticulectomy, concurrent myotomy, and a prophylactic antireflux operation. It is important to follow these principles to ensure optimal outcomes.